Basic Information
| Provider Information | |||||||||
| NPI: | 1366034639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMONS | ||||||||
| FirstName: | DARIUS | ||||||||
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| Credential: | CRNP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 COUNTRY DR | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194647222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1610310837 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2901 JOLLY RD | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102728221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2021 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP022492 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.